Article Text

Download PDFPDF
Risk factors for CMV retinitis among individuals with HIV and low CD4 count in northern Thailand: importance of access to healthcare
  1. Prattana Leenasirimakul1,
  2. Yingna Liu2,3,
  3. Choeng Jirawison4,
  4. Nitta Khienprasit1,
  5. Siripim Kamphaengkham1,
  6. Somsanguan Ausayakhun5,
  7. Jenny Chen2,
  8. Michael Yen2,
  9. David Heiden6,
  10. Gary N Holland7,
  11. Todd P Margolis8,
  12. Jeremy D Keenan2,9
  1. 1Department of Internal Medicine, Nakornping Hospital, Chiang Mai, Thailand
  2. 2Francis I. Proctor Foundation, University of California, San Francisco, California
  3. 3Harvard Medical School, Boston, Massachusetts, USA
  4. 4Department of Ophthalmology, Nakornping Hospital, Chiang Mai, Thailand
  5. 5Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
  6. 6Department of Ophthalmology and Pacific Vision Foundation, California Pacific Medical Center, San Francisco, California, USA
  7. 7Department of Ophthalmology, Ocular Inflammatory Disease Center, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
  8. 8Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
  9. 9Department of Ophthalmology, University of California, San Francisco, California, USA
  1. Correspondence to Dr Jeremy D Keenan, Medical Sciences Building S334, Box 0412, 513 Parnassus Ave, San Francisco, CA 94143-0412, USA; jeremy.keenan{at}


Aim To determine if poor access to healthcare is associated with increased cytomegalovirus (CMV) retinitis risk among patients with HIV with CD4 counts of <100 cells/μL screened in a resource-limited setting.

Methods This is a prospective cross-sectional study. Patients with known HIV and a CD4 count of <100 cells/μL attending an HIV clinic in Chiang Mai, Thailand, completed a standardised questionnaire and underwent dilated fundus examination. Participants without CMV retinitis were invited for repeated examinations every 3 months until their CD4 count exceeded 100 cells/μL. The relationship between various potential risk factors and CMV retinitis was assessed with logistic regression.

Results 103 study participants were enrolled. At enrolment, the mean age was 37.5 (95% CI 35.7 to 39.2) years, 61.2% (95% CI 51.6% to 70.7%) were male and the mean CD4 count was 29.5 (95% CI 25.9 to 33.1) cells/μL. 21 eyes from 16 (15.5%) participants were diagnosed with CMV retinitis. In multivariate analyses, CMV retinitis was significantly associated with lower CD4 count (OR 1.42 per 10-cell decrement, 95%CI 1.05 to 1.93), longer travel time to clinic (OR 3.85 for those with >30-min travel time, 95% CI 1.08 to 13.8) and lower income (OR 1.22 per US$50 less income, 95% CI 1.02 to 1.47).

Conclusions CD4 count, low income and longer travel time to clinic were significant risk factors for CMV retinitis among patients with HIV in a resource-limited setting. These results suggest that reducing blindness from CMV retinitis should focus on increasing accessibility of screening examinations to poor and hard-to-reach patients.

  • Infection
  • Public health

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.